Breast Reconstruction Information

Breast reconstruction surgery does not truly reconstruct or rebuild a true breast but attempts to make a mound of similar size and shape to the original or remaining breast. This should help the patient wear clothes more easily, eliminate the need for an external prosthesis, and possibly decrease body image problems resulting from mastectomy.

The reconstructed breast never has the exact look or feel of the original breast. The shape is often somewhat different. Scarring may be extensive and prominent. Creating symmetry with the remaining breast can be difficult to impossible and may require surgery on the opposite breast to reduce its size or lift it.

Timing of Surgery

Both immediate and delayed reconstruction are associated with a similar risk of postoperative healing problems, but in immediate reconstruction could delay recommended postoperative irradiation or chemotherapy. However, the patient is usually able to reduce or avoid mastectomy deformity and may reduce by one the number of surgeries needed for reconstruction. Several studies have shown that immediate reconstruction produces a better aesthetic result and reduces the overall cost and time required for reconstruction. These questions should be discussed in detail with the patient’s general surgeon, oncologist, and plastic surgeon. Immediate reconstruction is done only if all are in agreement. Delayed reconstruction may be done as soon as 6 weeks after mastectomy although it is more usual and may be more prudent to delay 3 to 6 months. It may be done any number of years after mastectomy provided the patient’s health and physical condition remain good.

There are two main categories of breast reconstruction:

1. Breast implant (alloplastic) technique
2. Flap (autologous) technique

Either technique can be performed immediately or as a delayed reconstruction.

Implant Surgery

Most implant reconstructions require two to three procedures. A one stage reconstruction with immediate placement of a permanent implant is occasionally possible.

Autologous Surgery

In autologous tissue reconstruction a breast mound is created by moving tissue with a predictable blood supply from another area of one’s body to the breast area. Plastic surgery terminology calls this tissue a flap. There are 3 most commonly used breast reconstruction flaps. 1) The TRAM flap (Transverse Rectus Abdominus Muscle flap); 2) DIEP flap; 3) the Latissimus Dorsi (back) flap.

Summary

There is no universally correct method of breast reconstruction. Each patient's desires and circumstances must be considered individually. Only about 50 % of mastectomy patients decide to have reconstruction. Each patient must consider issues of their disease control, medical fitness for surgery, body image, expectations, recovery period, and willingness to risk the complications and expected side effects of each procedure.

Federal law mandates that cancer patients may have the procedure of their choice if medically appropriate for all who have had mastectomies as well as surgery on the opposite breast to achieve symmetry. Your choice depends on your wishes and on physical factors that make a certain choice optimal, or difficult, impossible, and unsafe for you.

Anne R. DeLaney, M.D., Jann Johnson, M.D., Cheryl Huang, M.D., Kathy Givens, RN, NP, Karin Kidd, RN, Bettianne Weissler, RN

Department of Plastic Surgery

Kaiser Permanente, San Rafael

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